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Complimentary copy only,
click for free subscription.
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By Eric Jaquith
& Calvin Bruce
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The Impact of
Social Media Networking
This issue of the Jackson & Coker Industry Report
focuses on a growing trend within society at large and within the health care industry—the
use of social media networking (SMN) for personal and professional purposes.
The impact of a popular social media site is discussed
in a Time magazine cover story (June 15, 2009) entitled “How Twitter Will Change
The Way We Live.” It points out key elements of the Twitter platform--the follower
structure, link-sharing and real-time sharing--and it describes how useful this
popular social media tool is for enhancing personal communication, accessing valuable
news and opinion, facilitating advertising and marketing, and achieving other end-user
benefits.
This edition of the JCIR offers a Special Report and
two feature articles that discuss social media in terms of benefits to hospitals
and physicians.
Additionally, our slate of summarized articles
includes two of special significance: “Is Social Media the New Job Search Engine?”
and “This Sentence Easily Would Fit on Twitter: Emergency Physicians Are Learning
to ‘Tweet.’”
By the way, Jackson & Coker is poised to launch
corporate accounts on LinkedIn, Facebook and Twitter. We hope that you enjoy the
contents of this issue--and stay in touch with us regularly via these social media
outlets.
Cordially,
Calvin Bruce
Managing Editor
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By Robyn Melhuish
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By J&C Research Associates
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Medical Missions Newsletter
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By Lakshmi Onofri
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Policymakers Search for Ways to Anchor Ballooning Health Costs
Source:
Kaiser Health News
Date:
07/28/2009
Since the failure of the Clinton administration’s attempts to overhaul the American health care system in 1993, health spending has more than doubled and the number of uninsured has increased by 25%. Efforts now center on controlling skyrocketing costs, but even those efforts are criticized for their own costs.
Efforts at spending reduction tend to focus on cutting repeat hospital admissions, identifying the most effective and cost-efficient treatments, and encouraging healthier living, primarily through weight loss.
With regard to reducing readmissions, a major sticking point involves older patients. These patients, when discharged from hospital, have a 20% chance of readmission within a month, with readmissions costing Medicare $17 billion annually.
One proposal for cutting readmissions is to deploy nurse practitioners for transitional care. This, though, is a service generally underutilized due to a low reimbursement rate. While hospitals cut readmission rates significantly, they also lose the revenue they would have gained from these readmissions. At the same time, the programs increase costs for hospitals, making the worth of the programs questionable.
As to identification of effective treatments, this is easier said than done. It is simple to say right now that a program will identify the most effective treatments and make reimbursement standard for those at the expense of others. But what if a doctor disagrees with the treatment deemed most efficient by a governing body? What if the treatment will not result in several years of life, but several months? Some argue that applying one standard to idiosyncratic patients is a recipe for disaster.
The way forward on health care policy is fraught with potential for error. Only with careful discernment of the best all-around reform measures will the country see its way out of the current mess.
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‘Medical Home’ Gaining Traction, but at What Cost?
Source:
Urology Times
Date:
08/01/2009
The idea of the medical home is consistently raised as a part of the solution to the troubles facing the American health care system. But is the concept complete as it is currently envisioned? Some say the current plans focus too much on primary care providers, to the detriment of other, equally capable health care providers.
As currently envisioned, the medical home would consist of a team, led by a primary care physician, and tasked with the personalized coordination of a patient’s care throughout the health care system. This team would arrange consultations and use automated registry to more smoothly guide the patient’s treatment. The system focuses to such a great extent on primary care providers because it was developed by large employers inspired by the effectiveness of primary care spending in other countries. Further, the basic principles of the medical home were written by four primary care societies. As such, most of the large studies of the effectiveness of the medical home model center on the primary care provider as the centerpiece of the home.
This emphasis, some would argue, places undue focus on the primary care aspect when other specialties are equally capable of handling the medical home responsibility. Radiology, pathology, anesthesiology, dermatology--all these are excluded from the major studies.
Parties affiliated with these various specialties have voiced their concerns, only to be rebuffed by government spokespersons, who contend that it is unlikely that specialty practices would want to coordinate patient care to the degree necessary to constitute a medical home. They counter that it might not make sense to focus so heavily on primary care, and that doing so at the expense of specialty care may very well hinder efforts to improve the system’s efficiency and outcomes.
To open up the discussion, then, a number of groups have petitioned Congress to widen their view of which providers might constitute a medical home. They claim that dividing medicine and deciding which doctors should rank highest is not the job of the government, and that patients and physicians should decide on the best model of care in an individual case.
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Canada Keeps Malpractice Cost in Check
Source:
St. Petersburg Times
Date:
07/27/2009
The Canadian health care model is often proffered as an example for American politicians to emulate in reforming the American health care system. But could there be an even more important model in...Canadian malpractice policy?
A neurosurgeon in Miami can expect to dish out nearly a quarter of a million dollars per year in malpractice insurance. His Toronto counterpart will pay about a tenth of that, while his peers in Montreal and Vancouver will respectively pay about two-thirds and one third of what the Toronto physician pays. Why is this so? The disparity is due to some crucial differences between the American and Canadian malpractice models.
Under the Canadian model, a national cap places the maximum pain and suffering damages at around $300,000. Also, Canadian physicians buy their insurance from a nonprofit association, rather than a private provider, as is the case in America.
Other differences in policy abound, decreasing the likelihood of lawsuits against physicians. As a result, there are fewer nuisance suits and fewer settlements for said suits. Additionally, fewer punitive damages are awarded in trials.
Indicators point toward the United States moving a bit closer to the system used by its neighbor to the north. While it is unlikely that an insurance co-op will be started up, there are a number of states that have introduced damages caps, and the general trend in malpractice filings and payments has been downward.
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More Federal Money to Go Toward Physician Training
Source:
American Medical News
Date:
08/21/2009
While the debate over how to reform the health system continues, at least some action is being taken to address one of the many health care related challenges facing the nation—the federal government is putting money into attempts to head off the physician shortage.
The Department of Health and Human Services announced last month that it will distribute $200 million for the training of physicians and other health care professionals. The money is slated for the training of about 8,000 students and health professionals by the end of fiscal year 2010. Money will go to medical schools and educational institutions for the purposes of scholarships for disadvantaged students and loan repayments for faculty.
About 40% of the funds will be used for scholarships, loans, and loan repayment, while 25% will go to equipment purchases for training programs. Forty-seven million will go to supporting primary care training programs for residents, medical students, physician assistants, and dentists who will serve in underserved areas. A further $10.5 million will go to the training of public health workers, and $10.2 million will go toward scholarships for disadvantaged students.
The funds are part of the half-billion dollars allocated to the Health Resources and Services Administration for the purpose of addressing work-force shortages. The remaining funds will go toward the expansion of HRSA’s National Health Service Corps, a program giving scholarships and loan repayment for primary care physicians and physicians agreeing to serve underserved areas.
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SNOMED CT Will be Required by 2015 for Bonuses under Economic Recovery Law
Source:
Healthcare IT News
Date:
08/20/2009
“Meaningful use”--it’s a term that gives hospital administrators and IT professionals headaches. But this ill-defined requirement for federal healthcare IT funding is coming into sharper focus, thanks to recent decisions from the federal advisory panel on health IT standards.
The HIT Standards Committee has endorsed recommendations regarding the electronic recording of physician observations and how practices and hospitals will be reimbursed for investments in such technologies. SNOMED CT will be required for physician clinical observations by 2015. Starting in 2010, providers must use either ICD-9 or SNOMED CT to qualify for federal reimbursement for IT investments, and, beginning in 2013, they will be required to use ICD-10 or SNOMED CT.
ICD-9 and ICD-10 were originally intended for billing purposes and, as such, are likely unsuitable for denoting physician observations in an electronic health record over the long term; so it is expected that most will adopt SNOMED-CT.
These recommendations, along with others, are likely to shape the Centers for Medicare & Medicaid Services’ developing definition of meaningful use: the regulation to which providers must conform in order to receive federal reimbursement bonuses beginning in 2011.
Additionally, the standards committee endorsed updates to thirty performance measures approved by the Clinical Quality Workgroup. Included in these are 23 National Quality Forum measures already in use, which are being repurposed for EHRs, along with seven other measures regarding data collection for public health surveillance.
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The Impact of the Recession on Physician Recruitment
Source:
Journal of the Association of Staff Physician Recruiters
Date:
07/01/2009
The recession and the physician shortage: two things that barely need explaining any more. But how are these two factors combining to impact the world of physician recruiting? An article in the Journal of the Association of Staff Physician Recruiters takes a look.
As is well known by now, the country is in the midst of a deep recession. Credit markets have frozen, foreclosures have skyrocketed, and the stock market tumbled. Simultaneously, the nation finds itself heading toward worst-case scenarios with regard to physician staffing level, as the physician shortage looks to leave the country short 100,000 doctors within ten years.
And the effect of these downers on the physician recruitment market? Across the U.S., hospitals have frozen capital improvement projects and frozen acquisitions of new clinical technology and information technology. Simultaneously, the retirement funds of physicians have been hit hard by the recession. And the credit markets are still squeezed.
This means that older physicians are less likely to relocate due to personal lack of funds and greater difficulty in securing start-up capital for private practice. As such, older physicians continue to crowd areas that are searching for younger blood, when in times previous, they would have relocated to the rural areas that are experiencing physician shortages. In short, the physician shortage and the recession act in tandem to gum up the recruitment of physicians.
In light of this, experts recommend strategic investments in high impact physicians. It’s advisable for organizations to take into account market opportunities, broader community needs, and other factors when deciding which recruits to pursue. Thought should be given to the arrangements to be offered to physicians: Faculty practice plans? Integrated medical groups? Also, organizations should develop detailed primary care strategies, being sure to implement a model that is suited to their markets. These are, of course, short-term measures. As there is no certainty about the effects of the shortage on the recession or vice versa, it is difficult to make long-term projections. However, these are useful tips to keep in mind when deciding whom to bring on board during these uncertain times.
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Physician Recruitment: It’s all About the Leads
Source:
Journal of the Association of Staff Physician Recruiters
Date:
07/01/2009
The competition for quality physicians is at an all-time high. Additionally, the resources at hand for recruiters are typically significantly less than what has been available in the past. So how then to make sure your organization is getting the talent it needs? An article in the Summer issue of the Journal of the Association of Staff Physician Recruiters discusses.
The search for talent begins with building the pipeline to the talent you want. This involves a four-step process to ensure that the talent coming your way fits the needs of your organization. First, a recruiter has to make certain he is targeting the right leads. Strategic targeting of the right sort of leads–talent that falls into the specialty you need and has the professional and lifestyle interests to fit in your organization–is better than casting too wide a net.
Next, recruiters must understand what triggers–or, elements of the job offering–are the most appealing to that talent base. Then, recruiters must create the outreach message that encompasses those first two steps. The way you communicate must convey to talent that they are the right fit for your organization and vice versa. Lastly, in constructing the pipeline, you must find out how to reach your target population. Is it social media or print ads? Direct mail or an e-mail campaign? This all depends on who you want to reach and what you want to offer, and it’s up to the recruiter to figure out the best way.
In planning a search, strategic thinking is necessary to attract top talent. Recruiters will want to consider the type of physician most likely to benefit–professionally and personally–from this assignment. Also, recruiters should have an idea of what makes the assignment unique, as well as the strengths and weaknesses from the recruit’s perspective of the position. According to the author, the process is something like planning a vacation: Basic, no-brainer aspects of the search would include generic sourcing choice, like posts on organizational websites. Next, you consider situational needs—in this case, the tools focusing more on your target population: social media for residents, direct mail for clinical directors, and so forth. Finally, you pack accessories, those things that would be nice if space and resources allow for them: journal ads, exhibitions at specialty association conferences, and the like.
Having put together your recruitment strategy, it’s important to gather feedback from potential recruits, which includes talking to prospects about your outreach methods. It will also be useful to profile those prospects who responded to your outreach. You may discover that your methods tend to attract a certain type of individual, and this may be a good or bad thing depending on your recruiting needs.
While there is no absolute method for successful sourcing, it’s generally agreed that a good bet is the use of several sourcing vehicles. If you spread your (carefully strategized) message across numerous outlets, and if you have a good idea of what prospect would best fit in your organization, then you’re well on your way to maintaining a steady flow of recruits for your pipeline.
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Take the Initiative in Preparing New Employees
Source:
Urology Times
Date:
08/01/2009
As the saying goes, “Good help is hard to find.” But when you’ve found help–of any sort–how does one make sure that help becomes and stays good? An article in Urology Times recommends a kind of “boot camp” as a helpful solution.
Substandard performance in practices generally comes from lack of orientation and training of new employees. Thus, it’s advisable for practices to put new hires through a boot camp to acclimate them to the practice, its patients, and their position. Practice boot camp should include each of the following to better ensure a good fit for new hires:
-Job description–Let new employees know exactly where they fit into the system and what is required of them. Specific job descriptions for each position allow practice managers to properly evaluate their training processes to see what may need to be changed.
-Orientation–Orientation should cover everything related to working in a particular practice. Employees should be briefed on the practice history and overall mission and be provided with a personnel manual that clearly expresses office policies and regulatory requirements.
-Open dialogue–New hires should spend some time directly interacting with their supervisors. As such, an open dialogue and feedback policy is necessary, and new hires must be informed of it.
-Shadowing–Place new hires with an established employee who does the same work. That employee can explain the particulars of the practice and position better than could a handbook or other written material.
-Setting standards–Practice managers should develop standards for the tasks that are part of a position. These standards should be used to develop the training module that new hires will complete.
-Training schedule–New hires should have a structured process that tells them what elements they are to be trained in and in what order.
-Feedback–This is an essential aspect of boot camp. Employees must know whether they are doing the job correctly or not, as a failure to do so could result in bad habits or improper work, which drags down practice productivity on the whole as others attempt to make up for mistakes that could have been avoided with proper feedback.
Good help may be hard to find, but constructing a system like the one outlined above will ensure that any new hires that are brought on will at least know what is expected of them and where they fit in the scheme of things. That alone is likely to result in increased practice efficiency.
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Hospitals Must Meet Guidelines Before Recruiting Visa Waiver Practitioners
Source:
HealthLeaders Media
Date:
08/24/2009
J-1 visa waiver practitioners are looked upon by many as a way for hospitals to meet staffing shortages and serve underserved areas. But, in bringing in these physicians, hospitals must be careful to follow national and state regulations or face the consequences of a failure to do so.
Perhaps the most illustrative example of the need to adhere to national and state regulations regarding these waivers comes from Nevada. Some Nevada hospitals used J-1 visas without proper authorization, bringing practitioners on staff, overworking and underpaying them. The Nevada State Medical Association did not have the resources to stop this abuse until earlier this summer, but the damage had already been done. The Nevada health care industry suffered a black eye when a series of articles highlighted the problem.
Even working within regulations, the J-1 recruitment process is time-intensive and costly. It requires primary source verifications, background checks, and additional credentialing measures. Hospitals looking to begin the process should ensure that they are authorized for the process.
The Appalachian and Delta Regional Commissions, the U.S. Department of Health and Human Services, the Department of Veterans Affairs, and the Department of Interior for Indian Reservations are government agencies which may apply for J-1 visa waivers. Another avenue for foreign medical graduates is applying for the waiver through an individual state’s department of health. Through the Conrad 30 program, states can bring in up to thirty J-1 waiver practitioners per year for service in underserved areas. Additionally, a flex waiver program is available, wherein ten of the Conrad 30 waivers may go to non-underserved areas, but they must be designated for treating a significant number of underserved area patients. Finally, it is advisable for facilities and practitioners to apply early for consideration, as the process can take months to be completed.
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Employment & Compensation
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Is Social Media the New Job Search Engine?
Source:
Unique Opportunities
Date:
07/01/2009
If you’ve been paying attention to the Internet, you’ve seen it move very quickly in recent years from a static information repository to a dynamic medium by which innumerable individuals communicate with each other. The explosion of Web 2.0 has brought a wide array of user-generated content and networks in which users, organizations, and businesses interact with each other in a variety of ways. In the realm of health care, the Internet has opened up numerous new possibilities. Doctors now converse with each other via physician social networks and hospitals maintain Twitter accounts that update patients and interested parties on everything from policy shifts to outreach efforts to the progress of individual surgeries. It’s a new, connected world out there; so how does this all affect the health care job search process?
The first effect of the web on the health care job search process should be self-evident: these are networks, which makes them ideal for networking. Despite this, job searching on the Internet is still primarily the domain of recruiters. About 30% of all doctor recruitment stems from some Internet resource, meaning 7 of 10 hires are still conducted through traditional means.
In some areas, it seems, the old ways are still preferred. This is due in part to the number of older physicians who are responsible for hiring. These older physicians aren’t necessarily adept at Internet technologies; so their methods stay the same. This is bound to change, though, according to experts. Physicians are increasingly using networks such as LinkedIn to connect with fellow professionals. It is only a matter of time before such services supplant traditional means as the primary medium for recruitment.
With the advent of the social network job market, some new skills are required. For one, physicians will have to be better at selling themselves. Some make their profiles stand out via video CVs and other means, but the overall goal is to paint oneself as compelling and qualified. The new online persona comes with strings attached as well. Some helpful tips for maintaining a positive presence online are as follows:
-Don’t just accept everyone as a friend. Be discriminating in whom you accept and allow to comment on your network, as such information is available for all to see.
-Never post questionable media content about yourself. You’ll save yourself numerous headaches if you just think, “Would I be okay with my mother or my boss seeing this picture, video, or comment?”
-People are judging you based on your profile. This includes potential employers; so don’t post embarrassing pictures or inside jokes.
-If you have questionable material on a profile that pops up in a Google search, clean it up before launching a job search. Employers will Google your name nowadays to learn a side of you that might not appear on your CV.
-Have a recruiter or mentor review your social network page, looking specifically for things that might impact you professionally.
-Don’t tell an employer about your network page. There is no reason to open up the door to possibly disqualifying evidence.
-Stay professional in your networking. Following this rule can save you countless headaches in the future.
It’s a new world of job hunting out there, but with some common sense approaches to managing your online persona, you should have no trouble taking advantage of the new possibilities for connecting with prospective employers.
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Locum Tenens Contractual Issues
Source:
Locum Life
Date:
08/15/2009
The locum tenens lifestyle comes with a number of perks: travel, variety, and the like. But it also comes with its fair share of responsibilities. Chief among these are the contracts locum tenens professionals must adhere to in practice. These contracts are often written in legalese, but an article in the August issue of Locum Life illuminates the major contractual points you’re likely to encounter in practice.
Locum tenens professionals are likely to encounter six major issues in contracts. Knowing the ropes with regard to these major sticking points will ensure much smoother assignments with fewer surprises.
Malpractice–Malpractice insurance consists of two types: claims-made and occurrence-based insurance. Claims-made provides coverage for alleged malpractice during the period of time in which a physician is employed with the coverage and with claims made while the policy is in effect. Occurrence-based coverage covers a physician for incidents that occur during coverage no matter when the incident is filed. While claims-made insurance requires tail and nose coverage extensions for greater security, occurrence based-coverage has no such restrictions. Also, it is important for physicians to find out specifically about their coverage options when practicing overseas. Any potential employers overseas (or, really, at home) should be able to explain to you the sort of coverage you’ll receive and what your liabilities are.
Employment status/Scope of duties–These are essential facets of the contract. The employment status stipulates the physician’s status as an independent contractor, while the scope of duties sets out expected work hours, work week, and location as well as numerous other facets of the assignment. These should be clearly outlined within the contract so as to avoid any potential for confusion.
Compensation–Typically, locum tenens assignments are compensated on a per-hour basis, though there is room for alternative arrangements. No matter the arrangement, your contract should specify rate of pay, frequency of pay, and spell out any other benefits such as housing, travel expenses, car rental, malpractice, and other compensatory elements.
Non-compete clauses–In locum tenens, non-compete clauses typically forbid a physician from future locum tenens or full-time work within a facility to which he has been previously assigned without the consent of the agency. These agreements generally last two to three years after the end of an assignment. Extensions in employment are done through the locum tenens agency, and physicians should take care in negotiating with a hosting facility [the client], as doing so may be in violation of the employment contract.
Length of contract, notice, and termination–These should all be readily apparent within the body of a contract. In order to head off any potential confusion or litigation, policies regarding termination with or without cause must also be spelled out, as well as any means at the physician’s disposal for early termination of the employment contract.
Dispute resolution–Any contract should clearly spell out the contracting physician’s responsibilities with regard to arbitration or any other sort of dispute resolution. The contract should specify whether there is a preferred form of resolution or whether mediation, nonbinding arbitration, or binding arbitration are equally acceptable.
While this is by no means an exhaustive list of what to expect in a contract, it does constitute a list of the high points you’ll want to be sure to hit in reviewing a locum tenens agreement Ensure that all these factors are satisfactory, and you’re likely on your way to a hassle-free assignment.
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Hospital CFOs Aren’t Recession-Proof
Source:
Healthcare Finance News
Date:
02/03/2009
In the midst of a deep recession, one would think a hospital’s Chief Financial Officer to be indispensable, no? In fact, that is not the case. The story of a hospital in Blue Hill, Maine, demonstrates the lengths to which hospitals are going to stretch what finances they have.
Blue Hill Memorial Hospital, a 25-bed hospital in Blue Hill, Maine, is owed $3 million in state and federal funds for fiscal years 2006-2008. Further, the hospital has to clear $250,000 a month just to break even. As a result, numerous staff reductions have been instituted to stave off bankruptcy. On top of this, the hospital recently lost its CFO. Instead of immediately filling the role, the hospital has had other employees at the facility and Eastern Maine Healthcare Systems perform tasks to fill the CFO’s role while the hospital is in financial straits. The hospital’s actions have raised the question of whether or not the CFO role is expendable.
The hospital plans to take up to a year to replace its CFO, and even then might resort to creative solutions with regard to staffing. Possible solutions include sharing a CFO with another small hospital, hiring someone to handle CFO and COO duties part-time, or hiring a part-time CFO. Having sold investment stocks to make payroll, the hospital must, like others, make some hard choices and reinvent itself with an eye on cost-efficiency in order to continue operations.
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Physician Quality Officer Model Takes on a Successful New Look
Source:
HealthLeaders Media
Date:
08/21/2009
The path to achieving improved quality varies from institution to institution. UMASS Memorial Medical Center, however, has had a system in place since 2007 that has led to marked improvement and is attracting the attention of facilities across the nation.
UMMMC’s system has as a focal point the role of the physician quality officer. In the traditional hospital setting, the PQO is responsible for a clinical department, and his roles and input into quality improvement vary from institution to institution and department to department. UMMMC’s model calls for PQOs to focus on systems improvement, with the role centralized within a multi-disciplinary office rather than separate clinical departments.
Further, the traditional model has medical staff issues handled by the chief medical officer, but clinical departments are each responsible for quality improvement measures, regardless of proper training within the department’s management. This leads to fragmentation in work division between departments as well as an uncertain amount of energy and effort remaining for PQOs to address quality initiatives.
UMMMC developed a system wherein PQOs must be practicing physicians with clinical experience, interpersonal and team building skills, and a passion for clinical performance improvement. UMMMC’s selection committee identified 25 applicants, from which seven PQOs were chosen, representing surgery, internal medicine, pediatrics, pediatric emergency medicine, family practice, obstetrics and gynecology, and cardiology. UMMMC provided four two-hour sessions of Quality College to the new recruits, with the goal of increasing their knowledge of quality and patient safety. After this, they were assigned ongoing quality improvement projects in which they worked within various departments.
The system met resistance initially, as the changes would remove some power from department leaders since PQOs would report directly to the CEO. But, after two years, the system is hailed by all departments as a sizable improvement over the previous system. Hospital representatives claim the system has made leaders of the PQOs, and they have been effective in engendering support for quality improvement initiatives all throughout the system.
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How Much Charity Care Must Hospitals Give to Stay Tax-Exempt?
Source:
HealthLeaders Media
Date:
07/23/2009
Plans to require hospitals nationwide to spend at least 5% of their expenses on charity care are unrealistic and fail to account for the real, everyday differences in operations between hospitals in different areas, according to a study out from researchers at Yale University.
The study, authored by a senior fellow at the Urban Institute and a Yale University epidemiology and public health professor, examined disclosure reports at 20 of Maryland’s 45 acute care hospitals. The results of the study indicate that the level of “charitable care,” as defined by forthcoming national standards, varies from region to region, with some hospitals giving .05% of their resources to charity care and others 6.33%. The findings indicate that charitable care is dispensed by hospitals as is needed by their constituents. That is: poorer areas will have greater need for charitable care than will more affluent areas.
As a result, hospital advocates are arguing that other categories–health professionals’ education, community health services, mission driven programs and research–ought to be counted as charitable care, as rates of charitable care rise from 1.17% to 14% when considered along these lines. Experts warn that the struggle over charitable care reporting is likely to get worse as hospital budgets tighten, though it is not yet known how proposed changes to the health care market in the United States will affect the debate.
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Health Plans: The Questions You Should Be Asking
Source:
Medical Economics
Date:
07/24/2009
The modern medical practice is often beset by requests and offers from payers to join their plans. But is it worth it? An article in Medical Economics finds out how to tell who means more to whom in the deal: you or the prospective payer.
Central to deciding on whether to join a plan or not is the research and legwork done before deciding. Payer relationships should be built upon timely processing of claims, optimal reimbursement, and efficient time usage. The article puts forward a number of questions and issues that should be considered when making such a decision.
The first question is how the plan will affect the patient population. Practices should examine how many patients a plan will bring in. It may be necessary to limit the number of patients you’ll see if joining a large payer. Also, practices should keep an eye on the particulars of the plan, such as which employers use it and whether there are any exclusivity clauses.
Another question is how the plan will affect practice revenue. Check out the financial impact of joining the plan, obtain a fee schedule with procedure codes, and ascertain the policy on fee negotiation. Determine the basis for reimbursement, as this is crucial. Also, find out about the company’s disputed claim policy, as this is not something you want to find out the first time you’re working out a dispute with the company.
Are there any hidden traps in the contract? You’ll want to make certain of the opt-out period and the procedure for opting out. Also, watch out for a “hold-harmless” provision, wherein the practice would be solely liable for claims arising from the managed care relationship. It’s essential to have equal risk sharing among all parties. If there are quality-assurance reviews, make sure your practice knows how they’re handled. Lastly, find out the payer’s policy with regard to patient notification of medically unnecessary services.
Just because a plan is being offered doesn’t mean it’s the right fit for your practice. If, after asking yourself the necessary questions, you are still uncertain as to whether to join a plan, consult other doctors who are already members of the plan. They can likely tell you honestly whether you should join or not.
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Teenaged Brain: Part 1
Source:
Psychiatric Times
Date:
07/27/2009
Teenagers. They sulk about the house, wearing dark clothes and sassing anyone with the temerity to ask why they’re so sassy; that is: when they’re not bumping into things, wrecking cars, and generally taking stupid risks. Can we just blame it on their puberty-addled brains and be done? According to an article in Psychiatric Times, no.
Much has been made of the supposed link between “teenage” behavior and the neuro-architectural changes that accompany the onset of puberty. Researchers have observed fluctuations in volumes of both gray and white matter in the brain at varying stages of adolescent development. Additionally, fluctuations in the level of myelination of neural tissues have been observed at numerous stages of development. Still, though, the link between architectural changes and behavioral changes is tenuous at best.
As to questions regarding puberty’s effect on executive function: these, too, are somewhat facile explanations for complex mechanisms that are not yet fully understood. While puberty has been shown to coincide with structural alterations in the regions of the brain commonly associated with risk-taking, emotional regulation, and sensation seeking, drawing a causal effect from this correlation is a troublesome solution. For one, such a connection ignores contrary evidence, as executive functions also are in development throughout the elementary years. Also, it is not true that all teenagers are stimulated by risk-taking behavior throughout their teenage years.
Put plainly: it is far too early in our exploration of the brain and its relation to behavior to draw any concrete conclusions regarding the awkward years of pubescence. Put even more plainly: teenagers are a mystery, and we can’t quite blame it on their hormone flooded brains... yet.
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Payer & Reimbursement Issues
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How Universal Coverage Could Change Emergency Medicine, and Vice Versa
Source:
Annals of Emergency Medicine
Date:
08/01/2009
The debate rages on: how to reform, what to reform, and whether to reform in the first place. Proposals and counterproposals proliferate, and one gets the sense at least that momentum toward some change is building...at least in some areas. Within the health care system in America, an article in the Annals of Emergency Medicine takes a look at how (or whether) any reform will impact emergency department physicians.
Universal coverage is the focus of the times. By some estimates, upwards of 50 million Americans are without coverage, which translates to 120 million emergency room visits per year, resulting in increased costs, increased charity care, and an increasingly inefficient system. Any reforms to the system will have to take special note of emergency care, as well-meaning measures could backfire if providers refuse to serve patients holding a public insurance card like some currently do for Medicare, Medicaid and similar services. Still, the potential benefits of reform are plentiful, if a system can make it through the corridors of Washington.
The health care system as it exists today arose from a patchwork of policies meant to deal with the problems of a half-century ago, and the system creaks under the weight of the modern populace. The power structure that was built upon that system is the main obstacle to significant reform today. As a result, measures that would adversely affect the pockets of special interest players tend to stall in committee, as all players protect their own turf and reform moves slowly, if at all.
None of the plans paid the most attention during and since the presidential debates contains what some say would be the best solution, at least for emergency physicians: single payer. Some would argue that single payer option, in which the government covers all citizens, has been shown to be effective in nations such as Canada and Taiwan. Experts contend that, in the emergency department, a single payer system would result in reimbursement for more patients and an overall increase in revenues. Whereas some 40% of emergency medicine results in unresolved debt, under a single payer system this number would likely drop dramatically, with a reduction in paperwork and billing as an added bonus.
To this point, the single payer idea has been vilified enough that it is a political non-starter. Thus, any reform emerging from Congress will likely be a pluralistic system in which cooperation between the public and private sectors is urged. Whether or not such a system will be sufficient to address the real problems in health care delivery today and in the future, though, remains to be seen.
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Neverland
Source:
H&HN Magazine
Date:
08/17/2009
Should Health and Human Services learn to “never say ‘never,’” or at least say it less often? This question is posed in an article in the August issue of H&HN Magazine, which claims that Medicare’s nonpayment for so-called “never” events wrongly puts the onus on physicians and hospitals to prevent occurrences that may well be unavoidable in some situations.
While complications such as wrong-site surgery and retained surgical sponges are completely avoidable and should be classified as such, the article argues that other occurrences such as post-operative infections and pressure ulcers sometimes occur regardless of attempts to avoid them. If payers refuse reimbursement for treatment of such complications, the article predicts that their cost may be shifted to other billable services for the purposes of hospital solvency. In a worse case, hospitals could even deny care to high risk patients. While the government and payers can ignore the realities of these complications in the practice of medicine, hospitals and physicians have no such luxury.
Instead of the “never” system, the article presents the “health care warranty,” a guarantee on the part of the hospital for services rendered. Such a warranty would be added to the payment for the care of uncomplicated cases, computed separately for each patient according to the type and severity of his affliction. The warranty would provide composite measure outcomes for a given affliction for the purpose of determining expectations for quality and cost of outcome. Death and prolonged risk-adjusted length of stay would, of course, be designated as adverse outcomes. Research has demonstrated a correlation between adverse outcome rates and excess costs of care, and this correlation, along with predictive models for rates of adverse outcomes, can be used in the computation of a “warranty” for a particular patient. Hospitals performing better than predicted will benefit financially from a warranty, while subpar performance will result in costs exceeding the warranty payment, effectively penalizing them for the occurrence of “never events.”
Such a system, the authors argue, would be far fairer to institutions than blanket nonpayment for occasionally unavoidable occurrences. To continue down this path of nonpayment would be, they argue, unrealistic. Far better, then, to implement a system grounded in practice realism instead of expecting clinicians to unfailingly achieve an arbitrary wish list.
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Health Premiums Up 95% Since 2000; Income Up 17.5%
Source:
Philadelphia Inquirer
Date:
08/21/2009
Over the past nine years, the cost of health insurance has nearly doubled, and increases in wages are nowhere close to keeping up with the rise—this according to a Washington nonprofit group monitoring health care costs.
Families USA–a group advocating for affordable health care–recently released a report breaking down the steep rise in health insurance costs. The report found that the cost of an employer-provided family premium increased 95.2% between 2000 and 2009. In the same time period, median income increased only 17.5%.
Other disturbing trends mentioned in the study include:
-A 2000-2009 decline from 69% to 63% of employers offering health insurance to employees
-An 83% increase in employer premium prices from $4,531 to $9,955
-An increase from $1,297 to $3,161 in employee premium cost
-A 93.9% rise in the cost of an individual premium.
The study’s authors blame the rise in costs on increased use of medical treatments as well as increased cost of said treatments, inadequate oversight of the insurance industry, and lack of competition in insurance markets. Additionally, costs are passed on from the uninsured to the insured, as the uninsured receive care they cannot pay for, reasonably speaking.
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New AMA National Health Insurer Report Card Shows Improvement, More Work to Do
Source:
Physicians News
Date:
07/21/2009
The American Medical Association’s call for an overhaul of the health insurance industry’s billing and collection process has not gone unheeded. At the same time, the AMA claims there is much more room for improvement. An article in Physicians News has the story.
The AMA recently released the findings from its National Health Insurer Report Card through its Heal the Claims Process campaign. The report card, now in its second year, pointed out improvements since last year in the claims filing and payment system. After noting these improvements, though, the AMA renewed its call for an efficient, universal processing and payment system. The separate systems used by different payers, the AMA claims, introduce inefficiencies and waste that add up to $200 billion to the nation’s health care bill each year.
Additional findings of the report card include:
-A continuance of the inconsistency among insurers’ denials and reasons for denials of claims, indicative of a lack of standardization in the industry.
-Timeliness remains a problem, but prompt pay laws appear to encourage more timely reimbursement by insurers.
-There is room for improvement with regard to accuracy, but insurers have eliminated unnecessary reporting discrepancies.
-Transparency has improved since last year, although more evidence of this is to be expected.
Representatives of the AMA claim that the report card is indicative of the need for standardized procedures among the different companies to increase efficiencies and allow physicians to return to working with patients instead of worrying about administrative duties.
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Just Rewards? Healthy Workers Might Get Bigger Insurance Breaks
Source:
Kaiser Health News
Date:
07/28/2009
Could cutting out the smokes result in a lower co-pay? What about a decreased deductible for sticking to that diet? If some lawmakers on Capitol Hill get their way, these incentives could be the wave of the future. But their efforts are meeting resistance from...elements of the health care industry?
The controversy revolves around proposed legislation that would give employers greater leeway in how aggressively they try to engender healthier behavior among their employees. Some lawmakers contend that employers should be free to give discounts on health care coverage to employees that engage in healthier behaviors such as smoking cessation and weight loss. Under current law, employers and insurers are allowed to discount up to 20% of premium, co-payment, and deductible costs for workers participating in wellness programs. Proposed legislation would allow for this discount to be raised to 50%.
The resistance emerges from the AARP, the American Heart Association, and other groups. They claim that the proposal has the potential to unfairly shift costs onto workers unable to participate in such programs. While proponents of the measure say it would result in lowered costs, critics raise concerns about privacy and fairness. These wellness programs often ask probing questions, which critics say could be used to discriminate against employees. Further, they claim, many employees are unable to engage in wellness activities due to fiscal and family constraints.
Proponents of the measure counter that the proposed bill would include language allowing workers to substitute programs for ones that better fit their abilities and responsibilities. Further, they maintain that the cost reductions have already been realized on a smaller scale, as Safeway reports obesity and smoking rates among its employees at 70% the national rate due to just these sorts of incentive programs. Safeway representatives claim that their policy, adopted on the national scale, would represent a $550 billion reduction in direct health care costs for the nation.
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Credentialing, Licensure, Quality Management
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All Good Quality Intentions...
Source:
Modern Healthcare
Date:
08/10/2009
Quality improvement measures are supposed to improve patient outcomes, right? So why is one measure being removed from quality improvement guidelines due to fears that it could actually harm or kill patients? The development lends credence to the notion that mandatory quality measures aren’t necessarily the best medicine.
The controversy surrounds a measure known as AMI-6, which requires the use of beta blockers for heart patients. The administration of such treatment to heart patients upon arrival was previously a required measure for hospitals under the CMS and Joint Commission prospective payment system. Such treatment, though, had been shown by researchers to increase the risk of potentially fatal cardiogenic shock in patients with a history of heart failure. Despite this, the measure was still on the books until last year, when the CMS unofficially stopped the measure due to the risk.
The fact that CMS ended the rule unofficially, though, resulted in confusion among practitioners as to when the beta blocker should be administered and how to document such treatment. In most cases, such treatment is effective, but making the call in a pressure environment perhaps adds an unnecessary difficulty to the treatment of these already critical patients.
For its part, CMS claims the guidelines are not meant to be a set-in-stone dictate of medical practice, but rather guidelines for advisable practice. They claim the quality measures are developed collaboratively with medical practitioners to determine the best course of action. At the same time, though, the incident is indicative of the troubles that are bound to arise when guidelines regarding standard procedure are implemented on a larger scale.
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Leading a Culture of Safety
Source:
Trustee Magazine
Date:
07/01/2009
Trustees, senior managers, and clinical staff leaders should work collaboratively to improve patient care and organizational safety. Simple enough, no? Unfortunately, such has often not been the case in practice. An article in Trustee Magazine examines the ways hospital board leaders can improve interactions to shape a better functioning institution.
Since 1994, the Joint Commission on Accreditation of Healthcare Organizations [now, “the Joint Commission] 0.has had in its leadership standards the idea that collaboration among trustees and senior hospital leadership is essential for a well-functioning hospital. While this seems logical enough, there has actually been a history of conflict between hospital leadership groups. Since 2002, governing bodies and executives have faced competition from physicians and lawsuits from medical staffs. To combat the resulting negative effects on patient care, the Joint Commission convened a 29-member task force to address the leadership issue. As a result, a new leadership standard–effective January 2009–called for the development of a culture of safety.
The new standard calls for leadership to bring all hospital functions under one goal of promoting patient safety and care. This includes addressing the patient experience as well as adopting evidence-based practices. A safe environment requires that clinicians, staff, and the patient work together in an open and non-punitive atmosphere. The goal is a single entity composed of many parts operating toward one goal: improved patient outcomes.
For hospital leaders, this means understanding organizational culture by getting to know the workings of their hospital from the ground up. Management needs to know what metrics are most descriptive of overall institutional health and pay attention to those metrics. Whereas trustees are used to getting concise statements on such issues as finance, they should apply the same information-seeking processes to overall hospital safety. Quality indicators, such as CMS’ core measures of performance and “never-events,” are a good place to start, as low marks on these are indicative of a facility that has seriously gone off the rails. Also, trustees, beyond establishing the basics of safety, should identify the leaders in the field and seek to close the achievement gap between their hospitals and the best.
Another crucial safety measure is reduction of hospital-acquired infections. According to the CDC, hospital-acquired infections caused almost 100,000 deaths in 2002, adding $20 billion to health care costs. By developing a better relationship with medical staff and physicians, trustees can engender greater compliance with infection-fighting policies among staff. Listening to staff suggestions goes a long way to fostering this sort of trust, as does making plain the board’s backing of staff initiatives. Board experts don’t have to be medical experts or tell physicians how to practice, but in maintaining an open atmosphere and applying basic organizational skills, boards can ensure that their organizations are heading in the right direction.
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Industry Support of CME Fell 14% in 2008, ACCME Data Show
Source:
Medical Marketing & Media
Date:
07/23/2009
Support from pharmaceutical companies and medical device makers for Continuing Medical Education tumbled by a seventh from 2007 to 2008, according to new figures from the Accreditation Council for Continuing Medical Education.
The ACCME’s annual report showed that total commercial support for accredited CME dropped to $1 billion in 2008. This signals a decline of 14% in commercial funding for CME. Over the same time period, the number of physicians taking part in CME activities rose by 22%.
Commercial support for CME had been shown to be leveling off as of 2007. This leveling followed nearly a decade of sizable increase year after year since 1998, when the industry spent $301 million on CME. The decline in commercial funding also comes at a time when CME providers’ income is reported to have fallen and their expenses are reported to have risen.
The study also found that even as the number of physicians participating in CME activities rose, the number of activities dropped by 10%. Further, the number of logged CME hours rose 4%, and the number of non-physician participants rose as well. The declines in commercial funding come following budget cuts by drug and device makers as well as a number of high profile embarrassments for private entities with regard to CME funding.
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Getting the Most Out of Advancing Excellence
Source:
Provider Magazine
Date:
06/01/2009
Quality improvement campaigns: they have the potential to increase efficiencies and improve patient outcomes…but only if institutions actually participate in them. So what does it take to increase participation rates? A recent study in Massachusetts suggests that the answer could be as simple as improving communication.
Representatives of the Massachusetts Senior Care Foundation and the Advancing Excellence in America’s Nursing Homes campaign conducted a survey to find ways to increase facility participation in the Advancing Excellence campaign. Of the 457 nursing facilities in Massachusetts, 295 had joined AE. However, few of these institutions had participated in entering their organizational goals on the AE site.
To investigate this, researchers conducted a telephone survey of 213 facilities, asking why they had not fully participated in the program. Sixty-one respondents indicated they had entered organizational goals. Of those that had not, 107 had the needed data and entered it with assistance from research staff during the call. The remaining respondents indicated that they would find the data and enter it shortly. Few organizations indicated any technical troubles in entering the information, and even fewer indicated trouble developing goals. The main problem, it seems, was communication. Among respondents, many indicated that the person initially responsible for entering the information was no longer at the facility and had not passed on the information to anyone else. As such, facilities simply did not know they were supposed to enter additional information. Additionally, study results indicate that the facility goals process was regarded as largely a project of leadership, with facility staff unaware of where they fit into the process.
The researchers noted that facilities were, in fact, interested in compliance with AE upon being alerted to their responsibilities. To improve participation rates, they recommend increased communication between facility leadership and frontline staff. To integrate this into future iterations of AE, new information on improving communication within facilities has been posted on the AE web site. Additionally, the researchers recommend reducing staff turnover by setting targets, measuring results, and utilizing such data in the development of staff retention strategies. AE will also incorporate email reminders and additional resources to encourage compliance.
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Quality Data Have Limited Impact on Patient Behavior
Source:
American Medical News
Date:
07/13/2009
Physician rankings, message boards, quality rankings—these are the online scourge of a physician’s existence, right? Not so fast: a new study out from Harvard University researchers says these quality-data resources may in fact have little or no effect on patient behavior.
The study surveyed 4,200 participants randomly selected, examining patient behaviors with regard to the Massachusetts’ Group Insurance Commission’s tiering program for public employees. Under the MGIC tiering plan, physicians are divided into three tiers, ranked according to efficiency and quality analyses. Patients are given discounts for choosing the top-ranked physicians.
Despite protests by the AMA and other physician groups, as well as a few lawsuits—both charging that these sorts of programs steer patients toward particular physicians—the tiering program appears to have no effect on patient behavior. Among the survey participants, half had seen no information about tiering. Nearly a third knew about the tiering but didn’t know where their own physician ranked. And among those that knew of their doctor’s ranking, six out of seven found this out only during or after their first visit.
Contending that the Harvard study only looks at patients who are having one-off procedures, researchers are still looking into the possibility that the tiering systems have an effect on the behaviors of patients who are receiving multiple treatments through a physician. Additionally, physicians are examining the links between quality, health care costs, and high-deductible health plans.
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This Sentence Easily Would Fit on Twitter: Emergency Physicians Are Learning to “Tweet”
Source:
Annals of Emergency Medicine
Date:
08/01/2009
Seems like you can’t escape Twitter nowadays. The microblogging trend has caught on big across the Internet, as everyone from rock stars to congressmen is updating their day-to-day lives in 140 characters or less. But could the microblogging trend play a helpful role in healthcare? An article in the August issue of the Annals of Emergency Medicine has the story.
The American College of Emergency Physicians has recently found a use for microblogging. ACEP is one of a growing number of medical associations and hospitals that have jumped onto the Twitter trend as a means of disseminating information to followers in a timely manner. Traditionally, physicians haven’t regarded the web as essential to their practice, but this is changing. In fact, a recent survey found that 60% of physicians were interested in or already participating in online physician communities. The Twitter trend, then, is a continuation of the larger trend toward digital social networking among physicians.
And how are physicians using the microblogging service? Some share information about emergency medicine and advances in health information technology. The low character limit makes for concise updates, and followers can quickly determine their level of interest in a posting. Others are using the service to communicate with peers and hold conversations with like-minded physicians. The service is also used to spread medical literature and even to track disease outbreaks, as was the case with the H1N1 virus.
The service is only a few years old; so it may be too early yet to realize its full potential. However, Twittering doctors note that the service could, in the future, prove to be indispensable.
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eHealth Initiative’s Annual Survey Reports Sharp Increase in Data Exchange
Source:
Healthcare IT News
Date:
07/22/2009
According to numbers released recently from the eHealth Initiative, health information exchanges are proliferating and transmitting data at a high rate.
In the sixth annual eHealth Initiative Survey of Health Information Exchange, researchers found that the number of operational health information exchanges (HIEs) jumped from 42 in 2008 to 57 this year. This constitutes an increase of 40%. Of the operational HIEs, 40 reported achieving cost savings as a result of the exchange of health information.
HIEs report achieving cost savings through reductions in man-hours devoted to lab and radiology results, reduced clerical administration and filing time, fewer redundant tests, lowered chronic care patient costs, and fewer medication errors. Also, the study indicated improved access to test results for physicians without the disruption of care, as well as improved quality of practice life for participating physicians due to larger amounts of free time.
HIEs are in demand of late due to the recent passage of the American Recovery and Reinvestment Act, which stresses health information exchange as a cost reduction and outcome improvement method. At least $300 million in federal funds are scheduled for release to implement HIEs in 2009 and 2010.
The eHI survey identified 43 additional functioning initiatives that did not participate in the survey, and the group has collected information on 193 active HIEs across the nation.
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EHRs Have Open-Source Software Alternatives
Source:
American Medical News
Date:
08/24/2009
Electronic health record technology is touted as one of the miraculous measures to increase efficiency in the midst of wider reforms. Less talked about is the fact that adoption of such technology is still low due to the prohibitive cost of implementing such a system. A solution may be on the way, however, in the form of open-source software.
“Open-source”—a sort of catchall phrase meant to denote software that is freely available in the public domain for download and modification—could hold the key to providing access to EHRs in areas that might not otherwise be able to afford these systems. Participation in such systems makes a practice a part of a collaborative community that can be consulted for help whenever issues with the system arise. This sort of distributed troubleshooting, in combination with the free availability of such software, makes the open-source route an appealing alternative to the traditional paid systems.
There is, of course, a trade off. Adoption of an open-source platform requires a knowledgeable staff willing to research the system via the user community. It is this community that provides the tech support one would otherwise get from a vendor. Additionally, any open-source implementation will need to fit the Department of Health and Human Services’ “meaningful use” clause, which specifies that EHRs will have to provide “meaningful use” according to as-yet-unspecified HHS regulations. Further, there is no one to hold liable should something go wrong with your system, as open-source programs are generally developed anonymously.
The move toward open-source software has met with positive signs from government entities, as the Office of the National Coordinator included open-source connectivity in its push for the creation of the National Health Information Network. Such gestures indicate a growing acceptance of open-source offerings as real alternatives to proprietary software.
Important questions to consider for those interested in an open-source solution include:
-How long has the software been used?
-How many developers support it?
-What is the latest release available and how often are new versions released?
-What is the participation level like in online user groups?
-How many times has the software been downloaded?
It’s best to look for well-established offerings with multiple developers, recently updated versions, and an active user community. While open-source solutions are free, they’re not necessarily simple to implement. But with the right amount of preparation and the willingness to receive help from someone other than the vendor service line, an open-source offering could be the perfect fit for a cash-strapped institution.
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Physician Practice Management
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Hitting a Brick Wall: When Doctors Get Second Guessed
Source:
Southern California Physician
Date:
07/09/2009
Much talk is bandied about of late about institutions not “getting between doctors and their patients.” But, according to an article in the July issue of Southern California Physician, it is the insurance companies that tend to get in the way of physician decisions, and sometimes to deleterious effect.
The key phrase is “not medically necessary”-- an amorphous grouping of words that generally spells out why a payer thinks a procedure is being denied coverage in a given circumstance. The meaning of the term varies from payer to payer and situation to situation. Whereas a physician might assume the term means treatment falling under professional standards, payers varyingly define medical necessity dependent upon contractual scope, standards of practice, patient safety and setting, medical service, and cost. As a result, a physician might very well perform a covered procedure on one patient one day only to find the same procedure uncompensated on a different patient the next.
California, along with eighteen other state and county medical societies, filed a RICO lawsuit against the largest health plans in response to conflicts over medical necessity. Under the settlement, plans were able to push for cheaper treatments only when they were deemed at least as effective as the initial treatment. Even this measure, though, has hit a stumbling block, as the burden of proof of necessity is still on physicians rather than on payers.
The medical necessity clause is also used to deny treatment for most anything beyond mild medical interventions. This includes services such as smoking cessation assistance and even prescription drugs. The payers resist paying for vital treatments, and, when pressed, request additional patient information which may raise patient privacy concerns. The result is a delay in treatment which often causes further patient complications.
To address these issues, a number of legislative initiatives have been undertaken. In California, there have been attempts to establish a legal definition of medical necessity. The pitfall in this, of course, is that power shifts from the payers to the legislative body, not to physicians. Alternately, groups have attempted filing class action lawsuits against payers. Medical necessity suits, though, can only be filed individually in civil court. The lack of significant punitive damages as a motivating factor means that the payers can simply endure the suits and continue operations as usual.
In the end, the situation is flawed, but not irreversibly so. A good deal of red tape and bureaucracy must be overcome or circumvented in the process, but it is possible that some day the final say in patient treatment will rest where everyone claims they want it to be: between the doctor and the patient.
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Making Sense of Extended Warranties for Medical Equipment
Source:
American Medical News
Date:
07/13/2009
Buying some new medical equipment? Of course you’re getting the warranties along with it, but what does the language in that warranty mean? What should you watch out for? An article in American Medical News examines how to go about making sure you get the best out of your equipment and its warranty.
When purchasing equipment, there are generally three types of warranties: manufacturer’s, retailer’s, and extended. The former two generally are included in the price of the item. The third is an enhancement to the other two, generally extending their coverage for a longer time. In dealing with these warranties, two things are best to keep in mind:
-The length of the warranty and when the clock starts ticking on it.
-The ins and outs of coverage provisions.
Coverage for a warranty often commences upon purchase, running for an established period of time. So, upon leaving the store or signing on the delivery, the clock has started ticking. Extended warranties generally kick in once the first two warranties have expired. In the case that your manufacturer’s warranty is longer than your retailer’s warranty, that means that you will need to have your purchase repaired by its manufacturer in the event that it breaks before the extended warranty kicks in. To avoid this, you can negotiate an overlap in coverage with the seller of the extended warranty. In this way, you have the option of choosing whom to deal with for repairs or replacement.
Other things to keep in mind with regard to the warranty’s coverage are who determines the necessity of repair; what determines the necessity of repair; and whether normal wear and tear is covered. All of these things should be covered in the warranty contract. Upon signing the warranty, you will want to carefully take note of all conditions, limitations, and exclusions included in the contract.
Warranties can help you keep your equipment in top functioning shape or even provide a replacement should you have been sold a faulty machine. But these documents are only useful if you know them inside and out. A bit of reading and concentration up front can save you a lot of trouble in the future.
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Five Areas of Concern–Coding Targets Identified in the RAC Demonstration Program
Source:
Healthcare Finance News
Date:
07/23/2009
As the Recovery Audit Contractor program rolls out, organizations are prepping to deal with the workings of the program once it is fully up and running. Experts advise reaching for a full understanding of the workings of the RAC program with regard to specific coding areas. An article in Healthcare Finance News looks at some areas of interest.
The article points out five areas of focus that indicate a concentration of coding errors or medical necessity questions.
-Excisional Debridements–This procedure has consistently been shown to be a cause of coding errors. Non-excisional debridements are commonly miscoded as excisional ones.
-Inpatient Rehabilitation–It is necessary for organizations to ensure adherence to CMS guidelines for medical necessity of IRF admission, as a failure to do so could result in claim denial. Procedures involving a relatively intense rehabilitation program that requires a multidisciplinary, coordinated team approach for the purposes of upgrading patient ability to function fall into this classification. It is also necessary to make sure the services are reasonable and necessary for addressing the condition.
-Principal Diagnosis–Coding Errors: Complex Reviews–This occurs when coded principal diagnoses do not match the principal diagnosis code in the records. If the RAC determines a mismatch between code and diagnosis, you can expect an overpayment request letter for the difference.
-Wrong Diagnosis Code–Coding Errors: Complex Reviews–An example of such is the miscoding of septicemia. In the case of a misdiagnosis, the affliction could be coded as a urinary tract infection according to guidelines, which will result in the claim dropping to a lower DRG. In this case, the RAC will determine an incorrect coding once again and issue a repayment request.
-Outpatient Speech Therapy: Automated Reviews–An example of such is the billing of Medicare by an outpatient hospital for 15-minute blocks of therapy instead of per session billing. The RAC determines that the 15-minute blocks making up the rest of the session were unnecessary and files a repayment request letter.
These are but a few of the areas in which coding errors can occur. It is best to carefully review the criteria for a specific code before billing it to Medicare. Doing so may in fact save you and your coders a headache or two.
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